Anemia in pregnancy linked to differences in babies' brain development
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Researchers using a portable MRI scanner found that measurable differences in brain volumes emerged at around 12 months of age, offering some of the earliest evidence yet that maternal anemia shapes infant brain development in the first year of life and beyond.
The study, published in Brain Communications, followed 394 mother-infant pairs in Cape Town, scanning a subgroup of the infants' brains at several points between 3 months and 2 years of age.
Babies born to mothers who had been anemic during pregnancy had, on average, around 4% smaller total brain volume than babies born to non-anemic mothers. Differences were also found in three specific regions: the putamen, the caudate nucleus and the corpus callosum—structures involved in movement, learning, emotion regulation, executive functioning and communication between the two halves of the brain.
Over the first two years of life, the gap widened.
The corpus callosum was around 4% smaller in the anemia-exposed group by 12 months, but by 24 months, that gap had grown to 6%. This builds on previous research by Ringshaw, Donald and colleagues on toddlers and school-age children in South Africa that found comparable brain volume differences (between 4% and 8%) in these same brain regions. The new study shows that these differences can be detected as early as 1 year of age.
Even mild anemia left a mark
The observed differences in regional brain volumes were still evident despite most of the mothers in this cohort having only mild anemia. The researchers say these findings identify antenatal maternal anemia as a strong risk factor for altered child brain structure and highlight the importance of preventing and treating anemia before and during pregnancy.
Jessica Ringshaw, first author and researcher at King's IoPPN and the University of Cape Town, said, "What is striking about these findings is how early we are able to detect them. Seeing such prominent volumetric differences in infants exposed to anemia in the womb reinforces the importance of optimizing interventions for women both before and during pregnancy.
"In settings with multiple overlapping risk factors such as malnutrition and infectious disease, it is important to think about how they may be working together to drive anemia and, in turn, affect brain development. By tailoring interventions to the local context, we can make a meaningful contribution to society by giving children the best chance of reaching their full developmental potential—not only surviving but thriving."
Portable scans reach underserved communities
The study is also the first to test whether a portable, low-cost, energy-efficient MRI scanner can pick up these differences as reliably as a conventional hospital scanner. The team used both a standard 3 Tesla scanner and a lightweight 64 millitesla device that can be brought directly to communities, rather than requiring families to travel to a hospital. It also requires less infrastructure and specialized expertise and is significantly quieter than high-field scanners, meaning sleeping infants can easily be scanned without sedation.
The researchers say this opens the door to similar studies, including research assessing the efficacy of interventions, in parts of the world where conventional scanners are scarce.
"This study has proven that our novel technology can measure the impact of malnutrition on the developing brain, at scale, in some of the most challenging environments. This will provide an early, sensitive assessment of planned interventions," said Steve Williams, professor of neuroimaging at King's College London.
HIV added to anemia risk
Anemia in pregnancy affects more than a third of pregnant women worldwide, with the highest rates in sub-Saharan Africa and South Asia. While anemia is most often driven by iron deficiency due to diet or the body's inability to absorb it properly, infections such as HIV can also cause anemia. The team found that mothers in the study living with HIV had a greater risk of being anemic in pregnancy, which the researchers say may be due to indirect effects of inflammation on how the body processes iron from the food they eat.
Kirsten Donald, senior author and principal investigator of the Khula South Africa cohort at the University of Cape Town, said, "Anemia in pregnancy, much of it related to iron deficiency, affects millions of women and children worldwide. Until now, our ability to see what this means for early brain development has been very limited in the settings carrying the greatest burden. Measuring these effects directly opens up an important new avenue for understanding which maternal nutrition interventions can make a meaningful difference to children's developmental trajectories."
Publication details
Jessica E Ringshaw et al, Antenatal maternal anaemia and infant brain structure: high-field (3 T) and ultra-low-field (64 mT) MRI findings from South Africa, Brain Communications (2026). DOI: 10.1093/braincomms/fcag318
Journal information: Brain Communications
Key medical concepts
Corpus CallosumCaudate NucleusPutamen
Clinical categories
Obstetrics & gynecologyPregnancyChildren's healthNeurologyPediatricsCommon illnesses & Prevention Provided by King's College London Who's behind this story?
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